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Venous insufficiency occurs when the veins do not efficiently return blood from the legs back to the heart, usually due to malfunctioning valves or a chronic blockage, both of which can occur after a deep vein thrombosis. Chronic venous insufficiency is one of the most common chronic conditions in the United States and worldwide.

Symptoms

Varicose veins

Swelling of the legs and pain in the extremities (dull aching, heaviness, or cramping)

Discoloration of the legs (often a brown discoloration)

Hard, thickened skin around the ankles

Ulceration of the skin around the ankle

Diagnosis

Chronic venous insufficiency is usually diagnosed by a history and physical examination. Duplex ultrasound is also commonly used for assessment of the veins.

Treatment

There are several treatment options for chronic venous insufficiency. In most cases, the initial treatment is conservative and nonoperative. This typically includes:

Compression garments or stockings

Unna's boots, which are gauze bandages coated with zinc oxide to create a semi-rigid boot

If conservative treatment is unsuccessful, a more invasive surgical treatment is pursued. This treatment is focused toward eliminating or lessening the effects of the damaged valve function in the veins. Options may include:

Sclerotherapy

Vein stripping

Valve replacement surgery

Endoscopic perforator ligation

Laser vein ablation

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